TIME Infectious Disease

How Nigeria Is Keeping Ebola at Bay

APTOPIX Nigeria Ebola
Nigeria health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria, Aug. 4, 2014. Sunday Alamba—AP

Fears that Africa's most populous country would become a tinderbox for the disease have so far not come to fruition

Ebola is still running rampant in parts of West Africa. Over 1,500 people have died in Guinea, Sierra Leone and Liberia, where authorities have risked unrest by imposing nationwide curfew and quarantine zones.

But in nearby Nigeria, the government has largely contained Ebola in a single cluster traced back to the first imported case, and reported a total of only six deaths. The death of a doctor in Port Harcourt, in the south of the country, initially raised fears of a second outbreak when it was revealed on Thursday—but it soon emerged that his infection was also linked to the first Ebola case.

Health experts say that while more Ebola cases can’t be ruled out, Nigerian authorities quickly and effectively reacted to contain the disease, tracking people who had contact with patients, conducting widespread testing and quarantining suspected victims. “The response of the government has been robust,” said John Vertefeuille, who leads the Nigeria Ebola response team of the U.S. Centers for Disease Control and Prevention (CDC).

Ebola arrived in Nigeria on July 20, when Liberian-American financial consultant Patrick Sawyer flew from Liberia to Lagos, Nigeria’s commercial capital. Sawyer collapsed at the airport and was taken immediately to hospital, reducing chances of infecting more people in Lagos, a city of more than 21 million people.

He infected a few people before he was isolated, as doctors didn’t initially suspect Ebola and didn’t take full precautions. All other confirmed cases were traced back to him; eight have recovered, with only one case still being treated in isolation.

When the government realized Ebola had arrived on Nigerian soil, it acted quickly to coordinate international health organizations including the CDC, the World Health Organization, and recently Médecins Sans Frontières. It invited those groups to “come to the table and… insert themselves into those structures that the government has formed,” said Vertefeuille.

The work is divided into the management of confirmed cases who are treated in an isolation center in Lagos, and epidemiology and contact tracing, key to containing the virus.

Confirmed cases are treated in isolation, while those the victims made contact with pre-diagnosis are visited daily at their homes. If they develop symptoms, they too are taken to quarantine and tested. Nigeria began its program of contact tracing with Sawyer, and currently has more than 100 people under surveillance in Lagos.

But one man slipped through the net, Health Minister Onyebuchi Chukwu said Thursday. A Nigerian man who had contact with Sawyer developed symptoms and evaded surveillance, traveling to the oil industry hub of Port Harcourt last month, where he was treated by a doctor for his symptoms.

The man recovered and returned to Lagos four days later, after a manhunt for him had begun. The doctor, however, had contracted the virus and died on Aug. 22. The government has now begun contact tracing for him, and 70 people are now under surveillance there.

The man who escaped surveillance was an isolated case, Chukwu said. The fact that most people being treated at hospital have survived and were soon discharged has encouraged people under surveillance to cooperate. “Initially when we started we had one or two stubborn cases, but now they’re all cooperating,” he said.

As well as taking a rapid response approach to Ebola cases, the government has also been acting to stop the spread of misinformation about the disease. It has been issuing bulletins explaining how the disease spreads, and attempting to dispel rumors about unorthodox “cures” that have spread on the streets and on social media.

Benjamin Akinola, a 65-year-old retired army officer, said he and his wife bathed with and drank water with salt after a rumor suggested it could prevent Ebola. They stopped after hearing on the radio that it led to the death of some people. “People stopped it, and this is what the government is telling us,” said Akinola.

The government has also been pushing for better personal hygiene practice. Guards at supermarkets, banks, restaurants, and clubs will often spray people’s hands with sanitizers before entering.

The public relations operation seems to be working. Lawrence Obioha, a 43 year old newspaper seller in Lagos said initially fewer people attended his Sunday church service out of fear of Ebola. “Gradually it’s picking up,” he said. “There’s a lot of relief now that they know that at least there’s a response to treatment.”

While fears that Africa’s most populous country would become a breeding ground for the disease have so far proven unfounded, officials in Nigeria are under no illusion that the virus has been stamped out. “We have not eliminated the disease. We have not eradicated it,” said Chukwu. Over 200 remain under observation, and the infection is still raging in Sierra Leone, Guinea and Liberia. The battle against Ebola will continue in Nigeria for some time yet.

“This really could be a long and a hard fight,” said David Daigle, a spokesman for the CDC team on Ebola in Nigeria. “We’re optimistic, but we know that this is like a forest fire and if there’s just one ember left in place it could easily start back up.”

TIME Innovation

Five Best Ideas of the Day: August 28

1. New Orleans is at the heart of a new HIV epidemic, and only massive health system reform can remedy the situation.

By Jessica Wapner in Aeon

2. From dismantling Syria’s chemical arsenal to hunting down Joseph Kony, America’s military missions abroad far outlast the public’s attention span.

By Kate Brannen in Foreign Policy

3. To look beyond stereotypes and understand the programs and interventions that improve life for young men of color, the U.S. Department of Education invited them to a “Data Jam.”

By Charley Locke in EdSurge

4. Taking a page from silicon valley, incubators for restaurateurs can help get new ideas on the plate.

By Allison Aubrey at National Public Radio

5. So the homeless can work, worship, and transition to normal life, cities should offer safe, flexible storage options.

By Kriston Capps in Citylab

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Infectious Disease

Nigeria Confirms First Ebola Death Outside Lagos

Nigeria Ebola
Nigerian health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria on Aug. 4, 2014. Sunday Alamba/AP

Doctor who died in southeastern city marks Nigeria's sixth Ebola death

Nigeria confirmed Thursday the country’s first Ebola-related death outside Lagos, the country’s main international transit hub.

The victim, an unnamed doctor who died in the southeastern oil city of Port Harcourt, marks Nigeria’s sixth Ebola death in a recent outbreak of the disease primarily affecting West Africa. He is believed to have been infected by a man linked to Nigeria’s first Ebola case, Patrick Sawyer, who died in Lagos shortly after arriving there from Liberia.

The yet-unnamed doctor had died last Friday, but Nigerian Health Minister Onyebuchi Chukwu waited until Thursday to confirm the case, the BBC reports. The doctor’s wife has been put under quarantine, while an additional 70 people suspected to have had contact with him are being monitored in Port Harcourt.

While the death marks a blow to Nigeria’s efforts to contain the disease, Mr. Chukwu noted that while “the problem is not over . . . Nigeria is doing well on containment, all the disease in Nigeria were all traced to Patrick Sawyer.”

The Nigerian government said Wednesday that schools in the country would not reopen until October 13 in order to help prevent the outbreak from spreading.

Recent figures from the World Health Organization suggest Ebola has infected more than 3,000 people and killed over half of its victims, largely in West Africa. More than 240 health workers have been infected with the deadly virus, for which there is no vaccine or cure, though it is treatable and survivable. Ebola is not airborne, and is spread only when humans come into contact with the bodily fluids of those infected with the virus.

West Africa’s health ministers will be meeting later Thursday to discuss measures to address what’s become the largest-ever Ebola epidemic.

[BBC]

TIME Infectious Disease

Here’s How Ebola Spread in the Democratic Republic of Congo: WHO

A suspected Ebola outbreak in the Democratic Republic of Congo may have no connection to the outbreak in West Africa

On Tuesday, the Democratic Republic of Congo reported to the World Health Organization (WHO) that the country is having an outbreak of Ebola, which appears to be separate and unrelated to the outbreak in West Africa.

According to the information given to the WHO and provided to media, here’s how it spread: The first person to contract Ebola in the Democratic Republic of Congo was a pregnant woman who butchered a bush animal given to her by her husband. She was taken to a clinic after she started displaying symptoms of Ebola virus disease and died on Aug. 11 of a hemorrhagic fever, that at the time, was not yet identified as Ebola. The woman died, and was dealt with by health care workers.

The health care workers who cared for the woman, which included one doctor, two nurses, a hygienist and a ward boy, all developed similar symptoms and died. Similar deaths were discovered among relatives of the first pregnant woman, people who were in contact with the health care workers, and people who were involved in the burial process of all the men and women who died. According to the WHO, from July 28 to August 18 there have been 24 suspected cases of the disease there, which includes 13 deaths.

Currently, samples of those infected are being tested for Ebola.

The Democratic Republic of Congo Ministry of Health is currently monitoring the situation and is undergoing contact tracing with support from WHO.

TIME ebola

Nigeria Confirms 2 New Ebola Cases

Nigeria Ebola
Nigerian health officials wait to screen passengers at the arrival hall of Murtala Muhammed International Airport in Lagos, Nigeria on Aug. 4, 2014. Sunday Alamba/AP

The two are the first infected people who didn’t have contact with the ill traveler

Nigeria’s health ministry confirmed Friday two new cases of Ebola in the country, the first people to come down with the disease who didn’t have direct contact with an infected traveler who brought the virus into the country from nearby Liberia.

Nigerian Health Minister Onyebuchi Chukwu said both newly infected people are the spouses of two caregivers who contracted the virus and later died after giving treatment to Patrick Sawyer, the Liberian-American man who flew into the country infected with the virus last month.

Sawyer passed Ebola on to 11 other individuals before he died. The two new infections plus Sawyer bring the total number of Ebola patients in Nigeria during this outbreak to 14, five of whom have died while another five have recovered.

[AP]

TIME Infectious Disease

WHO: Ebola Casualties Top 1,200

A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on August 17, 2014 near Monrovia, Liberia.
A Liberian burial team wearing protective clothing retrieves the body of a 60-year-old Ebola victim from his home on August 17, 2014 near Monrovia, Liberia. John Moore—Getty Images

Another 84 deaths reported in just three days

The World Health Organization has tallied another 84 deaths from confirmed or probable cases of Ebola virus over the past three days, bringing the death toll in West Africa to 1,229 people.

The WHO released the updated figures on Tuesday and announced an increase in food and aid shipments to roughly 1 million people living within the quarantined areas of Guinea, Liberia and Sierra Leone.

“It is essential that people in those zones have access to food, water, good sanitation and other basic supplies,” the WHO said in a statement, adding that it had partnered with the United Nations World Food Programme to scale up its aide shipments to affected areas and target its deliveries to hospitals and quarantined homes. “Providing regular food supplies is a potent means of limiting unnecessary movement,” the organization said.

Liberia’s information minister said Tuesday that three Ebola-stricken African doctors who were treated with a regimen of the experimental drug, ZMapp have shown “remarkable signs of improvement,” Reuters reports. The minister also confirmed that 17 Ebola patients who escaped from a quarantine center in Monrovia had been found and transferred to a treatment center.

TIME Infectious Disease

WHO: Ebola Outbreak Countries Should Screen Departing Travelers

An MSF medical worker checks their protective clothing in a mirror at an MSF facility in Kailahun, Sierra Leone on August 15, 2014.
An MSF medical worker checks their protective clothing in a mirror at an MSF facility in Kailahun, Sierra Leone on August 15, 2014. Carl De Souza—AFP/Getty Images

Liberia, Guinea, Nigeria and Sierra Leone advised to conduct exit screenings to contain spread of virus

The World Health Organization (WHO) is asking countries affected by Ebola to conduct exit screenings of people leaving at international airports, seaports and major land crossings.

“Any person with an illness consistent with [the Ebola virus] should not be allowed to travel unless the travel is part of an appropriate medical evacuation. There should be no international travel of Ebola contacts or cases, unless the travel is part of an appropriate medical evacuation,” the WHO said in a statement. The West Africa outbreak has spread to Guinea, Liberia, Nigeria and Sierra Leone.

The announcement comes after a quarantine center was attacked in Liberia on Saturday. Reports suggest that around 17 Ebola-positive patients were taken from the center, which complicates efforts to track down and isolate people who may have come in contact with the disease. Blood-stained bedding was also stolen from the center, which officials warned may be able to spread the disease.

The WHO has created a Travel and Transport Task Force which will continuously monitor the outbreak in order to provide information and advice to the travel and tourism industry, but is currently not recommending any bans on international travel or trade. The WHO is also not recommending entrance screening for countries not affected by the disease and which do not share borders with affected countries.

The WHO also stressed that transmission of the virus on an airplane is a very low risk. People are contagious with Ebola once they start experiencing symptoms, and when that happens, people are usually too sick to attempt any travel. Ebola is also not an airborne disease, and can only be transmitted through direct contact with infected bodily fluids like blood and vomit. “Travelers are, in any event, advised to avoid all such contacts and routinely practice careful hygiene, like hand washing,” the WHO said.

People who are getting sick are usually family members and friends who are personally caring for a sick person or someone undergoing funeral preparations unprotected.

In a separate statement on Monday, the WHO addressed the threats experienced by health workers fighting Ebola. “Assaults on health workers and facilities seriously affect access to health care, depriving patients of treatment and interrupting measures to prevent and control contagious diseases. WHO has a specific mandate to protect the human right to health, especially for people affected by humanitarian emergencies,” Dr. Richard Brennan, director of WHO’s department of emergency risk management and humanitarian response said.

TIME Infectious Disease

Fake Cures and Ebola-Drug Sensationalism Need to Stop, WHO Says

WHO says there's too much hype for unproven treatments, and too many people claiming to have cures on social media

“Recent intense media coverage of experimental medicines and vaccines is creating some unrealistic expectations, especially in an emotional climate of intense fear,” the World Health Organization (WHO) wrote in a statement sent to the media on Friday.

Public fear and anxiety of Ebola is understandable, the WHO says, since the disease has no known cure or vaccine. But the organization warns that there needs to be more reason when it comes to fervor over experimental drugs that are in very limited supply. The WHO says that the public needs to understand that the majority of treatments available are not approved, and have not been tested in humans.

One of the more disturbing outcomes to come out of the Ebola treatment fervor are fraudulent cure claims on social media. “All rumors of any other effective products or practices are false. Their use can be dangerous. In Nigeria, for example, at least two people have died after drinking salt water, [which was] rumored to be protective,” the WHO writes.

Twitter is full of individuals claiming to know of Ebola “cures,” which the WHO is trying to combat, like the one below:

The U.S. Food and Drug Administration (FDA) put out a warning letter to consumers on Thursday about products claiming to treat Ebola. “Since the outbreak of the Ebola virus in West Africa, the FDA has seen and received consumer complaints about a variety of products claiming to either prevent the Ebola virus or treat the infection,” the letter says. “There are currently no FDA-approved vaccines or drugs to prevent or treat Ebola.”

Earlier this week, a WHO panel deemed it ethical to use experimental drugs and vaccines during the Ebola outbreak in West Africa, but it is still developing use guidelines from a panel of experts. The WHO says the Canadian government is donating doses of an experimental vaccine, adding that “a fully tested and licensed vaccine is not expected before 2015,” WHO says.

Recent numbers for Ebola continue to rise. The latest case numbers from WHO put the number of cases at 1,975 and deaths at 1,069. The WHO reports that there have been no new cases of Ebola detected so far in Nigeria, which is the most recent country to have a small cluster of the disease. The WHO says it is in the process of scaling up a massive international response. The CDC is currently tracking cases to prevent further infections, and the World Food Programme is delivering food to over one million people currently quarantined in zones where the borders of Guinea, Liberia and Sierra Leone meet.

TIME Infectious Disease

Doctors Inside Emory’s Ebola Unit Speak Out

Physicians at Emory University Hospital spoke to TIME about the unit treating the two U.S. Ebola victims, their doubters and the unknown future of emerging diseases

Emory University Hospital faced its share of doubters when it built its serious-communicable-disease unit more than a decade ago. At a time when the threat of infectious diseases in the U.S. seemed to have receded — replaced by worries over conditions like obesity and Type 2 diabetes — the center appeared unnecessary. But last week, when Emory got word that two Americans were infected with Ebola and would need to be evacuated from West Africa, health experts were all too glad the unit existed.

“I have to admit, a lot of people saw this as Noah’s Ark,” says Dr. Bruce Ribner, the infectious-disease specialist at Emory University Hospital leading the care of the American patients with Ebola virus. “They thought, ‘You are not going to have any activity there, you’re just wasting your time with all that.’”

Now Ribner is fielding an average of 100 emails a day from hospitals here and abroad seeking consultations, and there’s a caravan of news vans seemingly permanently parked along the sidewalk in front of the hospital, with news crews braving the thick Georgia heat in pitched tents on the grass.

“When [news of the patients] finally came, we said, ‘This is what we’ve been preparing for for 12 years,’” says Ribner. Indeed, the infectious-disease team caring for the patients with Ebola has been practicing the process of receiving and treating patients with serious diseases — like Ebola, SARS or anthrax — about two times a year every year since 2002, when it created its program and isolation unit with the help of the Centers for Disease Control and Prevention (CDC).

Dr. Alexander Isakov, who helped get the patients from their landed flight to the isolation room, remembers first hearing the news and thinking, Here’s a chance to finally activate all that they had been preparing for, to help people get better. “It’s gratifying,” he says.

Treating the Patients

Though Emory’s isolation unit was created with this precise type of health emergency in mind, experts stress that nearly all U.S. hospitals are equipped and prepared to receive a patient suspected to have contracted Ebola. When both patients were moved from the ambulance into the hospital, choppers ahead captured footage of the full-body protective suits with air-purifying respirators that were worn by the team. Emory says it’s trying to re-message the idea that physicians need to dress in what some are calling “moon suits” to care for a patient.

“Of course the message goes out that you have to dress like some sort of space person,” says Ribner. “Which is an unfortunate message.” The CDC recommends that anyone entering a patient with Ebola’s room wear at least gloves, a gown, eye protection and a face mask, with the acknowledgement that depending on the amount of fluids being excreted, more may be needed. The hospital agrees with this advice, and Ribner says his nurses felt more comfortable wearing the full-body suits. One of the features of Ebola-virus infection is diarrhea. “One [reason from our nurses] was just pragmatic: I don’t want my shoes full of feces. The other was, ‘You know what? These are kind of comfortable,’” says Ribner.

(The patients at Emory have requested privacy, but one released a statement Saturday saying he was getting “stronger every day.”)

Now that more cases of Ebola are spreading in Lagos, a highly trafficked city in Nigeria, the possibility for more patients in the U.S. is not out of the realm of possibility. “If we had to accept other Ebola patients — and we’ve been in contact about possibly doing that — we could do it,” said Dr. G. Marshall Lyon, one of the Emory physicians treating the patients with Ebola. Lyon says the unit also has a contract with the CDC to handle their employees, should any of them be exposed to serious communicable diseases.

A New Age of Infectious Diseases

While Ebola is new in the U.S., it’s not a novel virus, and health experts remain confident that the outbreak will eventually subside. Still, the current Ebola outbreak, the deadliest in history, begs the question: Is the U.S. prepared for other infectious, and even unknown, emerging diseases?

“We live in a world where we are all connected by the air we breathe, the water we drink, the food we eat, and by airplanes that can bring disease from anywhere to anywhere in a day,” says CDC Director Dr. Tom Frieden. “That’s why it’s so important to strengthen global health security and work with countries all around the world so they can do a better job finding threats.” (In recent months, the CDC experienced two lapses in lab safety that raised skepticism about protection oversight, to which Frieden assures, “We blew the whistle on ourselves and began a comprehensive and aggressive program to address lab safety here.”)

In his opinion, the U.S. is facing three threats when it comes to emerging disease: new infections and organisms spreading in different places; drug-resistant bacteria; and intentionally created organisms. “Those risks require us to put in place robust systems,” he says.

Lyon says he remembers reading an article about 20 years ago stating the age of infectious disease was over. It couldn’t have been more wrong. “The bugs have evolved and kept us on our toes,” he says. “We have to deal with things like tuberculosis and measles having a resurgence.”

In 2009, H1N1 emerged as an influenza virus with little known about its transmission or how virulent it was. Ribner says, “We were really lucky” it wasn’t more lethal. “Do I foresee down the road that we could have a more virulent influenza strain? We’ve had them in the past, so yeah, we could,” he says. “Would we handle it? We would handle it as best we could.”

Learning on the Job

Having two patients with Ebola under treatment in the U.S. not only gives them a better shot at life, but it grants doctors the opportunity to learn something. “We have the unique opportunity to look at a disease that we don’t usually see here,” Dr. Aneesh Mehta, the Emory physician who had what he calls the “honor” to be the first doctor to receive an Ebola patient into the isolation room. “For these two patients, if they agree to participate in research down the road, we will be able to really look in-depth at the pathogenesis and the immunological response to Ebola in ways that can’t be done in Africa.”

Mehta says the drills at Emory — as well as the attention being paid to the effectiveness of governmental responses to this pathogen — will help experts better understand how to take care of patients in the larger context of our health care system. “We can teach other health care systems and physicians not only here in the United States, but throughout the world because our processes seem to be working quite well.”

Dr. Jay Varkey, a physician who joined the Ebola care team this weekend, agrees. “My hope is that by providing excellent care here, that learn processes that can be translated and expanded. In my opinion, in a fair and just world, if these processes are really key to improving survival in a disease like Ebola, that countries that are developing can institute them.”

The Emory team is working 24/7 to neutralize the disease in the two infected Americans, and while it’s uncomfortable to be faced with the dark consequences of our interconnectedness, it’s comforting to know that for over a decade, despite questioning, highly trained specialists have been watching our backs.

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